Education and the moderating roles of age,sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment

BackgroundWe examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4).MethodsParticipants were 30,785 dementia-free individuals aged 55–103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School.ResultsCompared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P < 0.001) education were related to reduced CI risk. The decreased risk of CI associated with Middle education weakened with older baseline age (HR = 1.029, P = 0.056) and was stronger in women than men (HR = 1.309, P = 0.001). The association between High School and lowered CI risk, however, was not moderated by sex or baseline age, but was stronger in Asians than Whites (HR = 1.047, P = 0.044), and significant among Asian (HR = 0.34, P < 0.001) and Black (HR = 0.382, P = 0.016), but not White, APOE*4 carriers.ConclusionHigh School completion may reduce risk of CI associated with advancing age and APOE*4. The observed ethnoregional differences in this effect are potentially due to variations in social, economic, and political outcomes associated with educational attainment, in combination with neurobiological and genetic differences, and warrant further study.     

Ethnic inequalities in psychological distress among urban residents in the Netherlands: A moderating role of neighborhood ethnic diversity?

The main purpose of this study was to investigate whether neighborhood ethnic diversity moderated the association between ethnicity and psychological distress in the four largest cities of Netherlands. Multilevel linear regression analysis was used to assess whether the association between ethnicity and psychological distress differed by levels of neighborhood ethnic diversity. Results showed that the Turkish and Moroccan residents reported significantly higher psychological distress than native Dutch and Surinamese residents. In high ethnic diverse neighborhoods Turkish residents reported significantly less psychological distress than in low ethnic diverse neighborhoods. Ethnic diversity amplifies the risk of depression for some but not all ethnic minorities.     

Modifying and validating the Composite International Diagnostic Interview (CIDI) for use in Nepal

Background: Efforts to develop and validate fully‐structured diagnostic interviews of mental disorders in non‐Western countries have been largely unsuccessful. However, the principled methods of translation, harmonization, and calibration that have been developed by cross‐national survey methodologists have never before been used to guide such development efforts. The current report presents the results of a rigorous program of research using these methods designed to modify and validate the Composite International Diagnostic Interview (CIDI) for an epidemiological survey in Nepal. Methods: A five‐step process of translation, harmonization, and calibration was used to modify the instrument. A blinded clinical reappraisal design was used to validate the instrument. Results: Preliminary interviews with local mental health expert led to a focus on major depressive episode, mania/hypomania, panic disorder, post‐traumatic stress disorder, generalized anxiety disorder, and intermittent explosive disorder. After an iterative process of multiple translations‐revisions guided by the principles developed by cross‐national survey methodologists, lifetime DSM‐IV diagnoses based on the final Nepali CIDI had excellent concordance with diagnoses based on blinded Structured Clinical Interview for DSM‐IV (SCID) clinical reappraisal interviews. Conclusions: Valid assessment of mental disorders can be achieved with fully‐structured diagnostic interviews even in low‐income non‐Western settings with rigorous implementation of replicable developmental strategies. Copyright © 2013 John Wiley & Sons, Ltd.     

HCV screening based on dried blood samples and linkage to care in people who use drugs: A prospective study

BackgroundThe burden of hepatitis C virus (HCV) infection among people who use drugs (PWUDs) is considerable. We aimed to screen for HCV infection using the fingerstick dried blood spot (DBS) test and to describe the cascade of hepatitis C care among PWUDs in Madrid, Spain. We also evaluated the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) in this population.MethodsWe carried out a prospective study and collected samples and epidemiological data using a mobile unit. Viral infections were tested by immunoassay and RT-PCR assay. PWUDs with a positive result were contacted and referred to a specialized health center to confirm and treat the HCV infection.ResultsWe studied 529 PWUD samples; 49.7% were from persons who had previously used injection drugs (IDUs). Of these, 152 (28.7%) were positive for HCV antibodies, 122 (23.1%) for HCV RNA, 23 (4.3%) for HBsAg, and two (0.4%) for HDV antibodies (8.7% of those with hepatitis B). People who inject drugs (PWID) more frequently had positive HCV antibody titers (52% vs. 7.3%; p<0.001) and a positive HCV RNA test result (40.2% vs. 7.3%; p<0.001) than non-PWID. The time from sample collection to test results was 19 days. The next 104 individuals (85.2%) with active HCV infection were contacted to report their HCV test results. Of these, 63 (51.6%) had an appointment, 62 (50.8%) were evaluated in the hospital, and 56 (45.9%) started HCV therapy.ConclusionHCV screening using fingerstick DBS was an excellent tool for determining HCV prevalence and other chronic hepatitis viruses (HBV and HDV) in PWUDs. However, linkage to care was limited, mainly with respect to the initiation of HCV therapy.